Managed Care Cast

A Multidisciplinary Approach to Managing Complexities in Cancer Care by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care news included medical groups asking CMS to halt or slow down its plans to cut physician reimbursement for evaluation and management services; the Senate weighs a package of bills to combat the opioid epidemic; new research shows the Affordable Care Act pushed the uninsured rate down to 10%. Read more about the stories in this podcast: Medical Groups Tell CMS to Stand Down From Linking Reimbursement to Paperwork Burdens: https://www.ajmc.com/newsroom/medical-groups-tell-cms-to-stand-down-from-linking-reimbursement-to-paperwork-burdens What We're Reading: Senate Opioid Bills; Michigan's Medicaid Work Requirements; Missouri Abortion Ruling: https://www.ajmc.com/newsroom/what-were-reading-senate-opioid-bills-michigans-medicaid-work-requirements-missouri-abortion-ruling ACA Pushed Uninsured Rate Down to 10% in 2016, Even Mo

The September issue of The American Journal of Managed Care® highlighted research into social determinants of health and ways to address social determnants in the health system. In a commentary, Dhruv Khullar, MD, MPP, and Rainu Kaushal, MD, MPH, both of the Weill Cornell Department of Health Policy and Research, outlined how health systems can utilize data-sharing networks to deliver targeted care to high-need, high-cost patients. In this interview, Khullar outlines the idea of precision health, challenges the industry faces when trying to share data, and what steps can be taken to implement such care. Learn more about drug prices in the United States and efforts to lower them: “Precision Health” for High-Need, High-Cost Patients: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/precision-health-for-highneed-highcost-patients Language Barriers and LDL-C/SBP Control Among Latinos With Diabetes: https://www.ajmc.com/journals/issue/2018/2018-vol24-n9/language-barriers-and-ldlcsbp-control-among-latinos-w

Going Below the Surface of Healthcare Cost Discussions With Dr Bobby Dubois by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included a study on the impact physician burnout is having on care quality; the latest Affordable Care Act showdown took place in a Texas courtroom; the share of employers offering health coverage increased for the first time since 2008. Read more about the stories in this podcast: Physician Burnout Associated With Poorer Patient Outcomes: https://www.ajmc.com/focus-of-the-week/physician-burnout-associated-with-poorer-patient-outcomes What We're Reading: Co-Pay Accumulators; GOP Pre-Existing Conditions Bill; Supervised Injection Sites: https://www.ajmc.com/newsroom/what-were-reading-copay-accumulators-gop-preexisting-conditions-bill-supervised-injection-sites Texas Hearing Against ACA Wraps Up as Senators Tie Issue to Kavanaugh: https://www.ajmc.com/newsroom/texas-hearing-against-aca-wraps-up-as-senators-tie-is

Bringing Virtual Tumor Boards, Real-Time Data to the Point of Care by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included encouraging results from the Next Generation Accountable Care Organization model; concerns that CMS' new billing rules will hurt the sickest patients; a study confirms  the value of daily aspirin for patients with diabetes. Read more about the stories in this podcast: Next Generation ACO Model Saves $62 Million in First Year: https://www.ajmc.com/focus-of-the-week/next-generation-aco-model-saves-62-million-in-first-year Patient, Provider Groups Tell CMS Proposed E/M Service Cuts Will Hurt Sickest Patients: https://www.ajmc.com/newsroom/patient-provider-groups-tell-cms-proposed-em-service-cuts-will-hurt-sickest-patients ASCEND Results Confirm Aspirin Prevents Primary Vascular Events in Diabetes: https://www.ajmc.com/focus-of-the-week/ascend-results-confirm-aspirin-prevents-primary-vascular-events-in-dia

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care news included a panel mostly endorsed the use of patient-reported outcomes for coverage of chimeric antigen receptor T-cell therapy; the US Preventive Services Task Force released new recommendations for cervical cancer screening; research found accountable care organization penetration may be changing how physicians work. Read more about the stories in this podcast: Many Questions to Ask in Setting National Coverage for CAR T Therapies: https://www.ajmc.com/focus-of-the-week/many-questions-to-ask-in-setting-national-coverage-for-cart-therapies MEDCAC Panel Mostly Endorses PROs for CAR T Therapies: https://www.ajmc.com/newsroom/medcac-panel-mostly-endorses-pros-for-car-t-therapies USPSTF Updates Cervical Cancer Screening Recommendations: https://www.ajmc.com/newsroom/uspstf-updates-cervical-cancer-screening-recommendat

Currently, 30 million people in the United States have diabetes and the American Diabetes Association estimates that the total economic cost of disease was $327 billion in 2017. An additional 84 million American adults have prediabetes, and 90% of them don’t know they have it, according to the CDC. Given the high cost of treating diabetes and the large population with prediabetes, which puts them at an increased risk of developing type 2 diabetes, prevention has become a point of focus. At the annual meeting of the American Association of Diabetes Educators, held August 17 to 20, prevention and delay of type 2 diabetes was one of the 2018 priority topics. Today, we’re taking a look back to 2017, when The American Journal of Managed Care® convened a panel of experts to discuss diabetes prevention and the use of technology. Read more about the stories in this podcast: Peer Exchange—Technology in Diabetes Care: From Prevention to Disease Management: https://www.ajmc.com/peer-exchange/technology-in-diabetes-ca

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included CMS outlining a plan to encourage Medicare accountable care organizations to take on more risk, faster; a study found substantial growth in Medicaid managed care enrollment; an analysis showed nearly 1 in 5 inpatient hospital stays includes a claim from an out-of-network provider. Read more about the stories in this podcast: CMS Plans to Overhaul MSSP Program to Force More Risk on ACOs: https://www.ajmc.com/newsroom/cms-plans-to-overhaul-mssp-program-to-force-more-risk-on-acos CMS Proposal Is a Start for Making Risk More Appealing to ACOs: https://www.ajmc.com/contributor/travis-broome/2018/08/cms-proposal-is-a-start-for-making-risk-more-appealing-to-acos Medicaid Managed Care Grew Substantially From 1999 to 2012: https://www.ajmc.com/focus-of-the-week/medicaid-managed-care-grew-substantially-from-1999

Optimizing Number and Timing of Doctor's Appointment Reminders: An Interview With Dr John F. Steiner by Managed Care Cast

Health centers have been delivering comprehensive, high-quality preventive and primary healthcare to the country’s most vulnerable populations for more than 50 years. While health centers started out as a primary care safety net, they are increasingly taking a holistic approach. Kristina Wharton, of the Department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine, explained that these centers quickly branched out into mental health services and dentistry. Read more about the stories in this podcast: Ensuring Access to Prescription Medications in the Post-ACA Healthcare Access Landscape: The Essential Role of FQHCs in the Safety Net for the Underinsured: https://www.ajmc.com/journals/supplement/2018/the-patient-assistance-safety-net-how-many-need-help-how-many-are-helped/ensuring-access-to-prescription-medications-in-the-postaca-healthcare-access-landscape-the-essential-role-of-fqhcs-in-the-safety-net-for-the-underinsured Celebrating America’s Health Ce

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included, CMS allowing step therapy in Medicare Advantage plans in a bid to allow for drug price negotiation; larger practices with more resources, technology and care management processes have higher readmission rates than smaller practices; studies find that empagliflozin also reduces liver fat in patients with diabetes and nonalcoholic fatty liver disease. Read more about the stories in this podcast: CMS Will Allow Medicare Advantage Plans to Use Step Therapy to Negotiate Drug Prices: https://www.ajmc.com/newsroom/cms-will-allow-medicare-advantage-plans-to-use-step-therapy-to-negotiate-drug-prices CMS Approves Extra Payments for CAR T, Increases Other Payments in Final Rule: https://www.ajmc.com/newsroom/cms-approves-extra-payments-for-car-t-increases-other-payments-in-final-rule Larger Practices Spend More

One of the most common causes of liver disease in the United States is nonalcoholic fatty liver disease, affecting between 30% and 40% of adults, according to the National Institute of Diabetes, and Digestive and Kidney Diseases. It’s a condition in which excess fat is stored in the liver—a buildup that is not caused by heavy alcohol use. Despite how common nonalcoholic fatty liver disease (NAFLD) is, there are currently no approved medications on the market. In this podcast, we talk to a clinician involved with a program that uses lifestyle management and a patient advocate, who is trying to shape policy to help patients with NAFLD and its more extreme version, nonalcoholic steatohepatitis (NASH). Read more about NAFLD and NASH: Studies Point to Empagliflozin as First Choice for Fatty Liver Disease in T2D: https://www.ajmc.com/newsroom/studies-point-to-empagliflozin-as-first-choice-for-fatty-liver-disease-in-t2d Drug Approvals That Dr Aimee Tharaldson Is Keeping an Eye on for 2019: https://www.ajmc.com/con

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included a report that found quality issues and fraud in Medicare’s hospice program; the Trump administration expanded short-term health plans; cancer screening rates are falling short of targets. Read more about the stories in this podcast: Report Finds Medicare Hospice Program Beset With Quality, Care Issues: https://www.ajmc.com/newsroom/report-finds-medicare-hospice-program-beset-with-quality-care-issues Trump Administration Finalizes Rule for Short-Term, Limited Duration Health Plans: https://www.ajmc.com/newsroom/trump-administration-finalizes-rule-for-shortterm-limited-duration-health-plans What We're Reading: Part D Premiums; US Healthcare Spending; Consequences of Sudden Inactivity: https://www.ajmc.com/newsroom/what-were-reading-part-d-premiums-us-healthcare-spending-consequences-of-sudden-inactivity

Advancing Precision Oncology With the Syapse Precision Medicine Council by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included CMS reversing its decision to suspend the risk adjustment payment program; out-of-pocket costs and copayment accumulators put an HIV prevention drug out of reach for patients; research finds geography can determine posttreatment imaging for women with breast cancer. Read more about the stories in this podcast: What We're Reading: Resuming Risk Adjustment Program; New Endometriosis Drug; Lilly Denounces Drug Imports: https://www.ajmc.com/newsroom/what-were-reading-resuming-risk-adjustment-program-new-endometriosis-drug-lilly-denounces-drug-imports PrEP for HIV Prevention: Essential for Ending the Epidemic, but Out of Reach for Many: https://www.ajmc.com/focus-of-the-week/prep-for-hiv-prevention-essential-for-ending-the-epidemic-but-out-of-reach-for-many Geography Influences Type of Posttreatment Imaging

Nurse Practitioners: Taking on New Roles as Physician Shortage Grows by Managed Care Cast

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included patient advocates, providers, payers, and pharma commenting on the Trump administration's drug pricing plan; a survey that found physicians and payers believe progress toward value-based care is slowing; a study that questions the standards of evidence for breakthrough therapy approvals. Read more about the stories in this podcast: From Patient Advocates to Pharma, Groups Weigh in on Trump Blueprint for Drug Costs: https://www.ajmc.com/newsroom/from-patient-advocates-to-pharma-groups-weigh-in-on-trump-blueprint-for-drug-costs Novartis Will Freeze Drug Prices Through End of 2018, CEO Says: https://www.ajmc.com/newsroom/novartis-will-freeze-drug-prices-through-end-of-2018-ceo-says What We're Reading: 340B Lawsuit to Be Refiled; Digging Into Breakthrough Approvals; Screen Time and ADHD: https://www.ajmc.c

There are concerns that cancer care costs may increase as the site of provider-administers cancer drugs shifts from physician officers to hospital outpatient departments. Researchers in the July issue of The American Journal of Managed Care examined chemotherapy-related spending in Medicare Part B after controlling for patient characteristics, such as cancer type, and explored differences in chemotherapy utilization patterns between the 2 settings. In this interview, lead author Yamini Kalidindi, a research assistant at Pennsylvania State University and a graduate student in the department of health policy and administration, explains why the findings of her study differ from previous research and highlights the importance of considering patient characteristics such as cancer type. Read the paper in the July issue: Differences in Spending on Provider-Administered Chemotherapy by Site of Care in Medicare: https://www.ajmc.com/journals/issue/2018/2018-vol24-n7/differences-in-spending-on-provideradministered-c